Transcript of Dissociative Disorders

2. Family system analysis: i.e. heredity, stress, dysfunctional family system, etc; the impact of the chronic mental illness on the family system and individuals in the family; and attend to larger systemic issues, such as gender, race, ethnicity, and socioeconomic factors.(Mayi)

3. Treatment options: from the biopsychosocial perspective. Include therapy, medication and other treatment options, if applicable. (Adrienn)Content:Family of OriginContributing FactorsAbuse or neglect

Major trauma, sexual abuse during infancy or early childhood

Communication & attachment

Developmental model of family environment(Lyons-Ruth, 2008))Developmental model of family environmentA difficult family environment, i.e.exposure to trauma or abuse = increase in borderline, antisocial, and dissociative features. Current Family Processes:Response to stress, guilt, should emphasize creating a supportive environment

(300.12)(formerly known as Psychogenic Amnesia)Dissociative Amnesia is characterized by an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.DSM-IV-TR (2000)Essential Features of Dissociative DisordersDisruptive integration of conciousness relative to memory, identity, or perception of the environment

Disconnection maybe gradual, transient, or chronic…most commonly presents as a retrospectively reported gap or series of gaps in recall for aspects of the individual’s life history…gaps usually related to traumatic or extremely stressful events…amnesia for episodes of self-mutilation, violent outbursts, or suicide attemptsOutcome of DissociationEverywhere but nowhere – almost

Dx by private practioners; tend to find what they expect

Specialty centers or clinicsLocation Factorsimplies a gap (ex: hopes for the pothole at the corner will one day be filled in)

temporary loss of memory that will recover within a period of days or weeks

ex: hypnosis as Tx tool in surgery, dental, medical, and psychotherapyTypicalhad been identified in the affective blunting of Schizophrenia

found as free- standingAtypicale.g., uninjured survivor of a car accident where a family member was killed has inability to recall anything from time of accident through or up to 2 days laterLocalizedFailure of recall encompasses the person’s entire lifeGeneralizedFailure of recall for events subsequent to a specific time up to and including the presentContinuousCommon Memory Disturbances:Loss of memory for certain categories of information, such as all memories relating to one’s family or to a particular personSystematizede.g., combat veteran can recall only parts of a series of violent combat experiencesSelective

MoreDetails about Dissociative AmnesiaIndividuals who exhibit Generalized, Continuous, and Systematized types of Dissociative Amnesia may ultimately be diagnosed as having a more complex form of Dissociative Disorder (e.g., Dissociative Identity Disorder)Can present in any age groupDiagnosis in preadolescent children is more difficult.Can be confused with other disorders...(ADHD, Anxiety, ODD, etc.)More Prevalent now...

Possibly due to a greater awareness of the diagnosis amongst mental health professionals

DSM-IV-TR (2000)Diagnostic Criteria for DissociativeAmnesiaThe predominant disturbance is one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.oneThe disturbance does not occur exclusively during the course of Dissociative Identity Disorder, Dissociative Fugue, PTSD, Acute Stress Disorder, or Somatization Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a neurological or other general medical condition (e.g., Amnestic Disorder Due to Head Trauma)twoThe symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.threeFormerly known as Psychogenic Fugue.

Dissociative Fugue is characterized by sudden, unexpected travel away from home or one’s customary place of work, accompanied by an inability to recall one’s past and confusion about personal identity or the assumption of a new identity.

NOS is included for coding disorders in which the predominant feature is a dissociative symptom, but does not meet the criteria for any specific Dissociative Disorder

DSM-IV-TR (2000)IdentityDissociativeDisorderICD 300.14(formerly Multiple Personality Disorder/Split Personality)ACriterion A: two or more distinct identities or personality states are present in the individual.CCriterion C: the individual is unable to recall important personal information, and this inability is too severe to be attributed to mere ordinary forgetfulness.BCriterion B: these distinct identities take control over the behavior recurrently.Dissociative Identity Disorder Diagnostics:DCriterion D: the disturbance is not an outcome of substance abuse or general medical condition.Image retrieved on April 11, 2013 from: http://www.biography.com/imported/images/Biography/Images/Bio-now/Hero%20Images/08-2011/Bio-Now-Roseanne-Barr.jpgImage retrieved on April11, 2013 from: http://img2.imagesbn.com/p/9781416537489_p0_v2_s260x420.jpgCelebrities with Dissociative Identity DisorderRoseanneBarra subjective sensation, discomfort, or change in functioning that a patient or informant complains about.SYMPTOMS:HeadacheMemory loss - amnesiaTime lossTrancesDepressionMood swingsSuicidal tendenciesSleep disorders:insomnianight terrorssleep walkingAnxietyPanic AttacksPhobiasFlashbacksReactions to stimuli"Triggers"Alcohol and drug abuseCompulsions

RitualsPsychotic-like symptomsHallucinationsSymptoms:Headache Memory loss - amnesia Time lossTrancesDepressionMood swingsAnxiety, panic attacks, and phobias (flashbacks, reactions to stimuli or "triggers") Psychotic-like symptoms (including auditory and visual hallucinations) Sleep disorders (insomnia, night terrors, and sleep walking)Suicidal tendenciesAlcohol and drug abuse Compulsions and ritualsConfused and disoriented state:Others around may discern that the switch has happened by specific symptoms such as rapid blinking, facial changes, changes in voice or demeanor, or sudden change of track of the individual’s thoughts

Personality Alters:Main or primary- carries the person's given name; When this primary identity takes over or regains consciousness, the individual is usually passive, dependent, guilty and depressed.

Alternate identities:Usually dominant; have personalities which contrast the primary personality. Ex: may be dominating, hostile, aggressive, etc. Time required to switch between two identities may be a few seconds, or may be gradual.Signs: as noticed by othershttp://www.imdb.com/title/tt0183505/Individualized life experience characterized by distinct personal history, self-image, and identity variance in age, gender, and name

Rx of “other-self” behavior = disgusting, revolting, loathsome, frowned onAffects of DIDhttp://withfriendship.com/images/g/31401/Derealization-image.gifDerealization:The feeling that the world has changed or is not real, feeling of self-alienationimage retrieved on April 11, 2013 from: http://pulse.sfstation.com/files/2012/11/adamduritz.jpgAdam Duritz is known as the frontman of the popular alternative rock group, Counting Crows. He's also known for dating famous actresses like Jennifer Anniston, Winona Ryder and currently Emmy Rossum. What many people don't know about Duritz is his struggle with Depersonalization Disorder, an illness that makes him feel disconnected from reality. He opened up about the disorder to Men's Health Magazine.Depersonalization:ICD 300.6Mrs. Spinner is a 46 year old woman who was referred by her husband who described "attacks" of dizziness that his wife experienced that left her incapacitated. She described being overcome with dizziness and nausea 4-5 times a week, when the room would begin to "shimmer" and she had the feeling that she was " floating" and could not maintain her balance. The attacks almost always occurred at about 4PM, after which she had to lie down until 7 or 8PM. After feeling better she would spend the rest of the night watching TV, would fall asleep on the couch and go to the bedroom at around 3AM.

The patient was evaluated medically and all tests were negative. She was in fine physical condition. When asked about her marriage she stated that her husband was abusive verbally and demanding of her and her children. She admitted that she dreaded his arrival home from work each day. When she was unable to make dinner, her husband and children would have to go out to eat. He came home, watched TV and had no conversation with his wife.Case Study:Mrs. Spinnerabout Mrs. SpinnerQuestions1. What is her diagnosis?

2. What are the symptoms that helped you make this diagnosis? What diagnostic criteria do they relate to?

3. What are two other possible diagnoses and why did you not choose them?

3. What are two other possible diagnoses and why did you not choose them?

5. What therapeutic approach would you consider and why??In this case, the circumscribed nature of the amnesia and the perplexity and disorientation during the amnestic period, all following a psychologically stressful event, are quite characteristic.

DSM-IV-TR Case Book (2002)With the amobarbital interview it becomes clear that the amnestic period developed following a particularly traumatic and life-threatening experience. Amnesia that does not occur exclusively during the course of DID and is not caused by Delirium, Dementia, or Amnestic Disorder justifies the diagnosis of Dissociative Amnesia.The differential diagnosis of acute memory loss begins with a consideration of a Cognitive Disorder, such as Delirium, Dementia, or Amnestic Disorder, which may be caused by head trauma, cerebrovascular accidents, or drug use.

Chilebowski, S. M., & Gregory, R. J. (2012). Three cases of dissociative identity disorder and co-occurring borderline personality disorder treated with dynamic deconstructive psychotherapy. American Journal Of Psychotherapy, 66(2), 165-180.ReferencesTreatment forDissociative DisordersTreatmentPsychotherapy is the primary treatment for dissociative disorders. This form of therapy, also known as talk therapy, counseling or psychosocial therapy, involves talking about your disorder and related issues with a mental health provider. Your therapist will work to help you understand the cause of your condition and to form new ways of coping with stressful circumstances.

Psychotherapy for dissociative disorders often involves techniques, such as hypnosis, that help you remember and work through the trauma that triggered your dissociative symptoms. The course of your psychotherapy may be long and painful, but this treatment approach often is very effective in treating dissociative disorders.Other Dissociative Disorder treatment may include:Creative Art Therapy. Cognitive Behavioral Therapy. Medication. Creative Art TherapyThis type of therapy uses the creative process to help people who might have difficulty expressing their thoughts and feelings. Creative arts can help you increase self-awareness, cope with symptoms and traumatic experiences, and foster positive changes.

It's based on the idea that your own thoughts — not other people or situations — determine how you behave. Even if an unwanted situation has not changed, you can change the way you think and behave in a positive way.MedicationAlthough there are no medications that specifically treat dissociative disorders, your doctor may prescribe antidepressants, anti-anxiety medications or tranquilizers to help control the mental health symptoms associated with dissociative disorders.Alternative Medicine: HypnosisYour therapist may recommend using hypnosis, which is sometimes referred to as hypnotherapy or hypnotic suggestion, as part of your treatment for a dissociative disorder.

Hypnosis creates a state of deep relaxation and quiets the mind. When you're hypnotized, you can concentrate intensely on a specific thought, memory, feeling or sensation while blocking out distractions. Because you're more open than usual to suggestions while under hypnosis, there is some controversy that therapists may unintentionally "implant" false memories by suggestion. However, when conducted under the care of a trained therapist, hypnosis is generally safe as a complementary treatment method.What is the Prognosis?Dissociative Disorders can be effectively managed with intensive psychotherapy, and medication, when necessary. Psychotherapy, sleep and stress management, and psycho-education can significantly diminish the frequency and intensity of dissociative episodes. The earlier in life a person is diagnosed and treated, the better the prognosis. However, dissociative symptoms may be so disabling, a person with a Dissociative Disorder may have difficulty seeking help or staying in treatment. People with Dissociative Disorders may also experience depression, mood lability, suicidal thoughts or attempts, sleep disorders (insomnia, night terrors, and sleep walking),or panic attacks and phobias (flashbacks, reactions to reminders of the trauma). Furthermore, compulsions and rituals, borderline psychotic symptoms, somatization issues such as headaches, trances or “out of body experiences” or eating disorders may occur.How Can Friends and Family Help?Family members, a spouse, or friends can educate themselves to understand when a person with a Dissociative Disorder and history of psychological trauma is dissociating or is in crisis.

At these times, they can compel the person to seek professional help. They can also monitor medications and ensure that therapy appointments are maintained. Family members are likely to help a person with dissociation enter a treatment facility, providing emotional support and financial resources.What factors can slow recovery?Persons with a Dissociative Disorder and history of psychological trauma may be reluctant or afraid to seek treatment. Finding the proper diagnosis and appropriate treatment plan is especially important. Chemical dependency or alcoholism, or co-occurring psychological problems may also be prevalent among persons with dissociation. Concurrent substance abuse dramatically interferes with effective psychological and medical treatment. Persons with a Dissociative Disorder may have isolated themselves from family or loved ones, thus lacking an effective social support structure that is important to assist with their recovery.When Should a Client enter a treatment center?Any person with a severe history of psychological trauma or Dissociative Disorder should seek help from a qualified mental health professional. When dissociative episodes are occuring with frequency, or are profound, or when a person suffers from multiple identities, an intensive treatment program is an important choice. Weekly psychotherapy or medication will be ineffective at managing serious consequences of a Dissociative Disorder. A treatment facility, like PCH Treatment Center, has extensive experience working with persons suffering from dissociative episodes related to psychological trauma.5. Stimulants:These are used as dissociative identity disorder drugs when the patient displays severe depression, or in cases where depression is a cause of dissociative identity problems. Stimulants improve the central nervous system's response and make the person alert, wakeful, and active. This medication should only be taken in recommended doses and on a physician’s prescription. In addition, these medications are not suitable for some dissociative identity disorder patients. Examples of stimulant drugs include midafinil, methylphenidate, caffeine, and dextroamphetamine.4. Anxiety medication:These drugs are used for the treatment of dissociative identity patients who display excessive anxiety, or when anxiety is a trigger for dissociative identity disorder behavior. Anxiety can sometimes be an associated condition caused by dissociative identity problems. These medications help reduce anxiety. Xanax®, librium, valium, and ativan are some examples.3. Antipsychotics:These include chlorpromazine, aripiprazole, Risperdal®, Haldol®, and mellaril. These dissociative identity disorder drugs are used when the patient exhibits psychotic behavior. They work as mood stabilizers as well. Even if the dissociative identity patient is not diagnosed with psychosis, these drugs can be used to tranquilize and stabilize the mood. The drugs should be used strictly under the prescription and guidance of an expert physician.2. Depressants:Depressants are used to calm down certain dissociative identity disorder patients displaying violent and manic behavior. These drugs temporarily diminish hyperactivity of the brain. They are used to prevent seizures or respiratory disorders that can be associated with a dissociative identity disorder. Examples of depressants include carisoprodol, atropine, benzodiazepines, and cyclobenzaprine.1. Antidepressant drugs:These include citalopram, venlafaxine, phenelzine, fluoxetine, and sertraline. These drugs help reduce depression in some dissociative identity disorder patients. Antidepressants must be taken only under expert guidance as some of them have several side effects. Any change in the patient’s behavior due to the effect of medication must be monitored consistently.Dissociative Disorders1. Antidepressant drugs

2. Depressants

3. Antipsychotic medication

4. Anxiety medication

5. StimulantsSpecific MedicationsMFT & Dissociative DisorderDissociative Identity Disorder and the Process of Couple Therapy1. Little Research is on couple therapy and trauma

2. Research supports the benefit of family support and childhood trauma